Table 2.

Current policies related to antibiotic use and problems with their implementation

Policy area	Problems with implementation	Recommendations
Antibiotics are prescription only drugs	Discrepancy between number of regulators and retail outlets. No sanctions or penalties for non-compliance.	Allocate more resources to implement the law. Ensure appropriate sanctions and penalties are enforced for non-compliant providers. Public educational initiatives to raise awareness and take advantage of the high literacy rate.
Hospitals need a Drug ad Therapeutics Committee (DTC)	DTCs are not trained in antimicrobial stewardship methodologies and do not have access to current resistance data. Many hospitals do not have DTCs.	Provide tools/guidance on effective hospital antibiotic stewardship. Provide them with reliable and up-to-date resistance data.
Hospitals need an infection control committee	Standardized surveillance structures are not in place. Many hospitals do not have infection control committees.	Provide infection control committees with funding to carry out their activities and improve infrastructure. Train them to use standardized surveillance methodologies and indicators to monitor progress, such as HAI rates by department and hand washing compliance.
Laboratory enhancement program	Inappropriate resistance testing gives erroneous and discrepant results	Ensure quality of laboratory testing by issuing national testing guidelines, including quality control strains. Consider setting up a national reference center (center of excellence) for antibiotic resistance testing and overseeing external quality control. Create an interactive network for sharing information (data, guidelines, expertise).
National antibiotic resistance surveillance	Lack of communication between institutions regarding resistance data	Pool data from all hospitals to create a national resistance database. Release a national annual report that includes both antibiotic use and resistance data in the same document.
Hospital antibiotic use surveillance	No standardized reporting of antibiotic consumption data	Standardize antibiotic usage indicators to international units, like Defined Daily Dosage (DDD) per 100 bed days. Release a national annual report that includes both antibiotic use and resistance data in the same document.
Medical and pharmacy school curriculum	Insufficient emphasis placed on antimicrobial stewardship	Provide sufficient time to teach and train students on appropriate antibiotic use and resistance. Highlight the growing public health problem of drug resistance.
Standard treatment guidelines	Current treatment guidelines are outdated	Ensure timely and evidence based updates of treatment guidelines for infectious diseases, utilizing local resistance data.
Pharmacovigilance	Adequate funding and resources	Engage the center for pharmacovigilance in tackling the issue of inappropriate antibiotic prescribing.
Stop agricultural antibiotic use before harvesting products	Enforcement focuses on farmers producing for export	Enforce the law. Set up a similar national antibiotic use and resistance surveillance system for the agricultural industry. Compile a national annual report that includes both antibiotic use and resistance data in the same document.

List of current policies related to antibiotic use and resistance, problems with their implementation and recommendations to improve implementation.